Provider Demographics
NPI:1003007337
Name:ROBERTS PHYSICAL THERAPY & MASSAGE
Entity Type:Organization
Organization Name:ROBERTS PHYSICAL THERAPY & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:HD
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:804-747-0003
Mailing Address - Street 1:3900 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1414
Mailing Address - Country:US
Mailing Address - Phone:804-747-0003
Mailing Address - Fax:804-747-0043
Practice Address - Street 1:3900 GASKINS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1414
Practice Address - Country:US
Practice Address - Phone:804-747-0003
Practice Address - Fax:804-747-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203258174400000X
174H00000X, 204C00000X, 204D00000X, 207RS0010X, 2251X0800X, 225700000X, 261QM2500X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192519OtherANTHEM
VA7126635OtherAETNA
VA0702094OtherUNITED HEALTHCARE
VA3695276OtherAETNA
VA283517OtherSOUTHERN HEALTH
VA192519OtherANTHEM